Center for Food Science and Nutrition, Addis Ababa University, PO Box: 1176, Addis Ababa, Ethiopia.
United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia.
Nutrients. 2020 Jan 18;12(1):253. doi: 10.3390/nu12010253.
Stunting in children less than five years of age is widespread in Sub-Saharan Africa. We aimed to: (i) evaluate how the prevalence of stunting has changed by socio-economic status and rural/urban residence, and (ii) assess inequalities in children's diet quality and access to maternal and child health care. We used data from nationally representative demographic and health- and multiple indicator cluster-surveys (DHS and MICS) to disaggregate the stunting prevalence by wealth quintile and rural/urban residence. The composite coverage index (CCI) reflecting weighed coverage of eight preventive and curative Reproductive, Maternal, Neonatal, and Child Health (RMNCH) interventions was used as a proxy for access to health care, and Minimum Dietary Diversity Score (MDDS) was used as a proxy for child diet quality. Stunting significantly decreased over the past decade, and reductions were faster for the most disadvantaged groups (rural and poorest wealth quintile), but in only 50% of the countries studied. Progress in reducing stunting has not been accompanied by improved equity as inequalities in MDDS ( < 0.01) and CCI ( < 0.001) persist by wealth quintile and rural-urban residence. Aligning food- and health-systems' interventions is needed to accelerate stunting reduction more equitably.
撒哈拉以南非洲地区五岁以下儿童发育迟缓现象普遍存在。本研究旨在：(i) 评估社会经济地位和城乡居住情况如何改变发育迟缓的流行率；(ii) 评估儿童饮食质量和获得母婴保健服务的不平等情况。我们使用来自具有代表性的全国人口与健康及多指标类集调查（DHS 和 MICS）的数据，按财富五分位数和城乡居住情况对发育迟缓的流行率进行细分。综合覆盖率指数（CCI）反映了八项预防和治疗性生殖、孕产妇、新生儿和儿童健康（RMNCH）干预措施的加权覆盖率，可作为获得医疗保健的代理指标，最低饮食多样性得分（MDDS）则可作为儿童饮食质量的代理指标。在过去十年中，发育迟缓的情况显著下降，最弱势群体（农村和最贫困的五分位数）的下降速度更快，但在研究的国家中，只有 50%的国家实现了这一目标。减少发育迟缓方面的进展并没有伴随着公平性的提高，因为 MDDS（<0.01）和 CCI（<0.001）的不平等仍然存在于财富五分位数和城乡居住情况中。需要调整食品和卫生系统的干预措施，以更公平地加速减少发育迟缓。
